Peanut oral immunotherapy in very young children

Peanut oral immunotherapy is a disease-modifying treatment to raise the peanut quantity necessary to trigger an allergic reaction. Among children older than 4 years undergoing peanut oral immunotherapy, nearly 75–80% achieve desensitisation, although few gain lasting protection (eg, remission) after discontinuing oral immunotherapy. 1 Begin P Chan ES Kim H et al. CSACI guidelines for the ethical, evidence-based and patient-oriented clinical practice of oral immunotherapy in IgE-mediated food allergy. Allergy Asthma Clin Immunol. 2020; 16: 20 Crossref PubMed Scopus (38) Google Scholar Efficacy is balanced by an increased risk of treatment-associated anaphylaxis versus peanut avoidance, a preference-sensitive consideration manageable in partnership with a supervising allergist. 2 Chu DK Wood RA French S et al. Oral immunotherapy for peanut allergy (PACE): a systematic review and meta-analysis of efficacy and safety. Lancet. 2019; 393: 2222-2232 Summary Full Text Full Text PDF PubMed Scopus (154) Google Scholar , 3 Greenhawt M Shared decision-making in the care of a patient with food allergy. Ann Allergy Asthma Immunol. 2020; 125: 262-267 Summary Full Text Full Text PDF Scopus (5) Google Scholar , 4 Wasserman RL Factor J Windom HH et al. An approach to the office-based practice of food oral immunotherapy. J Allergy Clin Immunol Pract. 2021; 9: 1826-1838 Summary Full Text Full Text PDF PubMed Scopus (5) Google Scholar Oral immunotherapy outcomes in very young children (eg, younger than 5 years) show similar safety and higher effectiveness than in older paediatric populations: in previous studies, up to 98% of children (aged 9–70 months) achieved desensitisation, with lower adverse event rates than in peanut oral immunotherapy trials with older children. 5 Soller L Abrams EM Carr S et al. First real-world effectiveness analysis of preschool peanut oral immunotherapy. J Allergy Clin Immunol Pract. 2021; 9: 1349-1356 Summary Full Text Full Text PDF PubMed Scopus (10) Google Scholar , 6 Vickery BP Berglund JP Burk CM et al. Early oral immunotherapy in peanut-allergic preschool children is safe and highly effective. J Allergy Clin Immunol. 2017; 139: 173-181 Summary Full Text Full Text PDF PubMed Scopus (203) Google Scholar However, many felt that a randomised, placebo-controlled oral immunotherapy trial in younger children was still needed. Efficacy and safety of oral immunotherapy in children aged 1–3 years with peanut allergy (the Immune Tolerance Network IMPACT trial): a randomised placebo-controlled studyIn children with a peanut allergy, initiation of peanut oral immunotherapy before age 4 years was associated with an increase in both desensitisation and remission. Development of remission correlated with immunological biomarkers. The outcomes suggest a window of opportunity at a young age for intervention to induce remission of peanut allergy. Full-Text PDF